Acute Hypoxic and Refractory Respiratory Failure Induced by an Underlying PFO: An Unusual Case of Platypnea Orthodeoxia and Transient Complication after Transcatheter Closure

Case Reports in Critical Care
Carlos Salazar, Romeo A Majano

Abstract

Platypnea orthodeoxia (PO) is an infrequent condition of dyspnea with hypoxemia, increased by adopting an upright position and is relieved in decubitus. This condition may occur in patients with hidden intracardiac shunts, usually across a persistent foramen ovale (PFO). The incidence of PFO in general population is quite common, around 27%; however, the concurrent presentation with PO, especially in acute refractory respiratory failure, is extremely rare. PFO closure in this setting is still the treatment of choice with significant improvement or complete resolution of symptoms after closure with an overall periprocedural complication in the first 24 hours of approximately less than 5%. A transient ST-segment elevation in the inferior leads is present in extremely rare occasions and most likely is induced by either an air embolism or a mechanically provoked spasm of coronary arteries. We report a case of an 83-year-old woman in acute hypoxic and refractory respiratory failure in whom PO was identified, most likely induced by a hidden PFO. The patient underwent percutaneous transcatheter closure and developed immediate chest pain, transient hemodynamic instability, and ST-segment elevation in the inferior leads; nevertheless, o...Continue Reading

References

Sep 1, 1983·Journal of Applied Physiology: Respiratory, Environmental and Exercise Physiology·C Marshall, B Marshall
Jan 29, 2000·Heart·P KublerP Garrahy
Jun 27, 2002·Journal of the American College of Cardiology·Martin U BraunRuth H Strasser
Jan 29, 2005·Cardiology Clinics·Grace Pei-Wen ChenEdward A Gill
May 13, 2011·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Jonathan N JohnsonDonald J Hagler
May 21, 2011·JACC. Cardiovascular Interventions·Swarnendra K Verma, Jonathan M Tobis
Oct 9, 2012·Journal of the American College of Cardiology·Jonathan Tobis, Michael Shenoda
Oct 18, 2012·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·Kate MarriottRoess Pascoe
Jun 10, 2014·Clinical Cardiology·Joseph T KnapperLaurence S Sperling
Jun 13, 2015·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Mohammad Khalid MojadidiJonathan M Tobis
Apr 18, 2017·European Heart Journal Cardiovascular Imaging·M MuratoriM Pepi
Sep 10, 2017·Interventional Cardiology Clinics·Ahmed N MahmoudMohammad Khalid Mojadidi
Sep 14, 2017·The New England Journal of Medicine·Jean-Louis MasUNKNOWN CLOSE Investigators

❮ Previous
Next ❯

Citations

Oct 3, 2021·BMJ Case Reports·Rajkumar RajendramGabriele Via

❮ Previous
Next ❯

Methods Mentioned

BETA
X-ray
sedation

Related Concepts

Related Feeds

Atrial Filbrillation

Atrial fibrillation refers to the abnormal heart rhythm characterized by rapid and irregular beating of the atria. Here is the latest research.

Atrial Fibrillation

Atrial fibrillation is a common arrhythmia that is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism. Here is the latest research.

Arrhythmia

Arrhythmias are abnormalities in heart rhythms, which can be either too fast or too slow. They can result from abnormalities of the initiation of an impulse or impulse conduction or a combination of both. Here is the latest research on arrhythmias.